NPI | 1114022050 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AZ 3214) |
Enumeration Date | 2006-09-14 |
Last Update Date | 2019-09-11 |